FROM THE BENCH analysis . The medical teams provide patient counseling and care , along with expertise and educational materials from the New Jersey Poison Control Center , and the city of Newark Department of Health and Community Wellness offers remediation and lead abatement services for city residents to maximize the public health benefits of the work .
At delivery , cord blood samples are collected to test newborns . The obstetrics and neonatal teams drew on experience gained from perinatal HIV transmission studies to test and associate data from mother – baby pairs at birth . As a result of implementing the program as standard of care , Bind said , “ we were able to completely shatter our goals of 500 women — we ’ re at about 6,000 or 7,000 now .”
An Unrecognized Problem
Given Newark ’ s history , the team members were pleasantly surprised when only 1 percent of the tested population exceeded the health limit for lead . But even more surprising , about 10 percent of tested babies were born with levels of mercury above the health limit , and a full 50 percent fell within a range expected to cause some health effects .
The mercury findings presented a bit of a challenge .
“ The response is not as well established as with lead ,” Bind noted . “ With lead , you have programs , you have funding , you have tracking ; with mercury none of that ’ s in place .” The team has been working with APHL , CDC and other groups like the Pediatric Environmental Health Specialty Units ( PEHSU ) to identify protocols and resources to help the hospital track affected children .
“ Until this , we didn ’ t have any way of identifying such patients ,” Nwobu said . “ It would have gone unrecognized .”
Most of these cases occurred within immigrant communities . With mercury speciation tests , the laboratory staff helped identify exposure sources and rule out possible concerns about mercury exposure via vaccines . Most cases were linked to behaviors such as fish consumption and the use of specific skin products .
“ To identify where this mercury was coming from was an epiphany for a lot of the patients ,” Nwobu said . That knowledge allowed the team to tailor and translate educational materials and engage relevant community partners , such as doula programs , religious organizations and family support services .
Babies found to have elevated mercury and / or lead levels were monitored through the hospital ’ s pediatric high-risk follow-up clinic . Staff were able to collect data on how quickly lead levels drop with or without chelation .
“ If we had … waited to the one-year [ test ], which is the [ American Academy of Pediatrics ] recommendation , we will have missed these patients ,” Fofah said .
Seeing Results
During the two years of the project , the percentage of babies born with no detectable mercury or lead has gone up . Anecdotally , the team has also seen metal levels drop in individual women during the course of pregnancy . These improvements happened concurrently with the COVID-19 pandemic , so they want to do more testing and longitudinal analysis to tease out possible factors .
“ But all indications at this point are that it ’ s coming from the increased awareness that we ’ re seeing through the program ,” Bind said .
The team has received institutional review board approval for retrospective chart reviews to compare metal levels and birth outcomes such as gestational age more directly , birth weight and head circumference . Preliminary data suggest better outcomes in women who received prenatal screening and early interventions through the clinic compared with those who delivered at the hospital but did not receive prenatal care there .
They have gotten funding to extend the program in University Hospital for another two years and hope to establish standard of care testing in a second hospital . They are also seeking ways to integrate lead and mercury testing into routine prenatal care covered by insurance , much like iron testing is currently . The “ pie in the sky goal ,” Steffens said , is to expand the program to the entire state of New Jersey and have the costs fully covered by thirdparty payers .
“ It will probably be some time before we get to that point . … But I will say that I ’ m optimistic about it . We are slowly but surely moving toward that direction .” n
Onajovwe Fofah , MD Uchenna ( Chris ) Nwobu , MD
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Summer 2021 LAB MATTERS 17 |